Vol 7, No 4 (2000)

Diagnosis of musculoskeletal tumors is quite often difficult and for the accurate diagnosis close collaboration of specialist in orthopaedic oncology, morphologist as well as roentgenologist is required. The more precise diagnosis of bone tumors can be made at specialized Centers (but not centers for general oncology) where roentgenologists and morphologists are trained for musculoskeletal tumors. Leading role in the collaboration of orthopaedic surgeon, roentgenologist and morphologist belongs to the clinician. These theses are confirmed by adduced clinical observations. The causes of diagnostic mistakes are analysed.

Compression device for osteosynthesis in trochanteric fractures is elaborated. Sufficient strength and stability of the femur fragments osteosynthesis in various types of trochanteric fractures was verified in the experiment on biodummies. Such level of strength and stability provides the possibility of early functional loading on the operated extremity. Surgical treatment using this device is indicated to elderly and senile patients without concomitant pathology as well as to patients with compensated changes in inner organs and systems after adequate preoperative management. The elaborated technique was applied in 37 patients. Results for the period up to 1 year were evaluated in 30 patients. Surgical treatment using new compression device is shown to allow decrease the rate of insufficient results to 3.3% as compared to 31% in conservative treatment.

The experience in treatment of 3 patients with rupture of Achilles tendon due to steroid injections in connected with achillodynia or tendoperiosteopathy of calcaneal tuber is presented. There 3.5% of patients with such pathology out of all patients with Achilles tendon rupture. In those patients the tendon rupture was shown to be caused by insignificant physical load (quick walking, slight jump). Postoperatively all patients had complications in form of diastasis of cutaneous wound margins. In one patient necrosis of wound with tendon involvement was noted. 3.5 months after operation the wounds healed by granulation. The severity of postoperative course was noted to be directly proportional to the number of corticosteroid injections into Achilles tendon.

The experience in treatment of children with neglected congenital hip dislocation is presented. The main principles of management are defined. The successive complex of curative measures including conservative treatment using Ter-Egiazarov-Sheptun functional plaster bandage in children over 6 months is described in detail. In failed conservative treatment the reduction of dislocation is performed using over head technique. In children over 3 years descent of femoral head and reduction of dislocation are carried out on distraction system followed by surgical correction of all dysplastic elements of the hip joint. Technique of detorsion-varus osteotomy with application of distraction system and closed reduction is described. Long-term results were evaluated using CITO score system in 255 patients. Good and satisfactory results were in 91.7% of cases.

The basis of hip joint implant elaboration is the principle of primary stable fixation of its components. This is achieved owing to the peculiarities of the implants design, its shape, proportions, surface structure. The stem of the implant is wedge-shaped in three dimensions («triwedge»). The cup has a shape of truncated cone with a spherical segment as an apex. In the proximal stem and spherical segment of the polymeric cup there are porous inserts with pores of 150-350 mkm. This provides the bone ingrowth into implant without disturbance of its nutrition as proved out by the experimental data. The implant is made of high-quality materials by modern production process. Since 1999 more than 600 operations using new implant were performed in Belarus. 173 patients were operated on at the Trauma and Orthopaedic Clinic of the Belarus Institute for Advanced Medical Studies during 1997-1999. Preliminary results are favorable.

After total hip replacement with Sivash’s implants marked metallosis by chromium, cobalt and to a lesser degree by molybdenum develops in tissues contiguous with the joint. Titanium and tin are also determined in considerable amounts. At experimental (2 months to 5 years) and clinical (3 weeks to 15-19 years) follow up all metals are determined in the connective tissue. In bone tissue only small amounts of metals were present even in long term follow up. In short terms metallosis develops in the zones close to the mobility unit and gradually distributes along the bone marrow canal. As shown by experimental data metallosis is detected only as traces when the implant without friction units is used. In stable and unstable implants the degree of metallosis was the same although its incidence was higher when loosing developed. Our data confirm the possibility of the total hip prosthesis loosing but it develops gradually and manifest clinically in late terms.

According to the literature data reliably increasing rate of pathologic processes and diseases manifestating by back pain is noted. Because such conditions are treated by physicians of different specialities there is not unity in the definition of these pathologic processes. The attempt to analyze historic and gnosiologic origin of vertebrologic terminology is undertaken. It is shown that such diagnosis as «osteochondrosis» possesses no constructive information and this causes the difficulty in management of patients. Authors suggest that the diagnosis must reflect the pattern and location of the pathologic process that ill help the physician to perform specific diagnostic and therapeutic programs. Classification which characterises the spine pathology in detail is given.

Post-traumatic deforming arthrosis of the ankle joint is a severe complication of damage to articular structures. The severity of its clinical manifestations depends on a number of factors: the time elapsed since the injury, the severity of primary anatomical disorders, the activity of reparative processes, the presence of tibiofibular diastasis, the state of the ligamentous apparatus, paraarticular tissues, and neurotrophic disorders.

Tendopathy at the point of attachment of the tendons to the bone (insertional tendinopathy) is a consequence of typical overload injuries and is observed mainly in athletes. It is known that the same load can lead to both positive adaptation with tendon hypertrophy and its subsequent strengthening, and dystrophic changes in the area of attachment with a decrease in tendon strength.

Honored Doctor of the Russian Federation, Doctor of Medical Sciences, Professor V.M. Lirtsman. It is difficult to believe in this: sharpness of mind, instant reaction, ability for accurate analysis, sparkling humor (and sometimes sarcasm) - all these qualities have only increased in him. And the wisdom that comes with age seems to have been born with him. So, maybe the classic was right and “all the calendars lie”?

Nikolai Ivanovich Pirogov, an outstanding surgeon, world-famous scientist, founder and classic of military field surgery, was born on November 13 (25), 1810 in Moscow in the family of Ivan Ivanovich Pirogov, treasurer of the Moscow food depot. At the age of 14, on the recommendation of the Dean of the Faculty of Medicine of Moscow University, one of the founders of Russian traumatology, Professor E.O. Mukhin was admitted to the medical faculty of the university. At the age of 17, he graduated from the university course as a doctor of the 1st department. Patron NI. Pirogova E.O. Mukhin recommended him as the most capable student as a candidate for the students of the "Professor's Institute" of the University of Dorpat. Having passed the entrance exam at the Academy of Sciences in St. Petersburg, Nikolai Ivanovich in 1828 went to work at the University of Dorpat. From the first days, in addition to working in the clinic, he devotes a lot of time to anatomy and animal experiments. A year later, he was awarded a gold medal for a competitive work on the topic “What is observed when large arteries are ligated during surgery?”.